Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
While I am not a dentist, tooth problems are an integral part
of emergency medicine, and it is worthwhile speaking about
them.
Teeth are the only exposed bone of the body. They are
constantly under attack by food particles and bacteria which
are normal inhabitants of the mouth. Despite the existence of
simple interventions to keep teeth healthy, few people do
them.
The rules are very basic: brush after every meal, don't
smoke, floss daily, get cleanings twice a year, and use
fluorine. If you do these simple rules, your chances of never
needing dental care are very good. I have a toothbrush at
work and dental floss in my pocket at all times for use
during the day.
Let's discuss the problems:
1) Tooth eruption: this can be very painful for youngsters,
although it is not usually a cause for high fevers, so
doctors are advised to look elsewhere for a source and not to
ascribe fever to simply ,"Teething." Pain control is
generally all that is necessary, although teenagers may need
surgical removal of their third molars or `wisdom teeth' if
there is a lot of pain -- they commonly get impacted, meaning
they don't grow in straight and push aside the established
teeth.
2) Caries, or cavities, can be very painful and may present
with a lot of swelling in the face. Compassionate doctors
will either give a dental block anesthesia, or give pain
relievers, which many times should include narcotics.
3) Post extradition pain is pain after a tooth has been
pulled. A difficult problem to deal with, here oil of cloves
may be the best bet. Make sure the dentist that took out the
tooth is available to help if this occurs.
Periodontal problems are problems with the gums. The gums
anchor the teeth, and should be light pink in color; dark red
or easy bleeding are signs of infection. Better brushing and
flossing can take care of this problem, but one who is not
careful could lose his teeth. Sometimes the bacteria invade
the weakened tissue, and cause fever, bad breath, gum pains
and grayish and fiery red gums. This is trench mouth, and it
requires immediate antibiotics.
5) Root canal involves sealing a tooth after taking out the
diseased nerves and blood vessels. Sometimes there is a
buildup of gases underneath the seal that will be extremely
painful; no amount of pain relief will help. The seal needs
to be opened and gases released. Again, don't let anyone do
root canal on you who isn't available and on call in case
this happens.
6) Teeth that are suddenly knocked out need to be dealt with
immediately. They should never be scrubbed clean, as this
destroys the delicate ligaments that will anchor them back
in. With baby teeth, do not return the tooth, but in adult
teeth immediate return is important. If you are unable to
return it, storage in milk or saliva is the best, but see a
dentist urgently. Teeth that are only broken are less urgent,
but still need to see a dentist as soon as possible; correct
treatment may avoid root canal or removal of the tooth and
prevent infection. Teeth that are knocked "loose" may just
need a soft diet for a few days, or may need a brace to
stabilize them. Write me in care of the Yated.
